Anesthetic and Circulatory Management of Pancreatic and Adrenal Tumor Surgery in a Patient with Hypertrophic Obstructive Cardiomyopathy(HOCM) Using FloTrac® Monitoring System

Abstract

A 66 year-old male, who had pancreatic and adrenal tumor with severe HOCM, underwent a surgical tumor resection under general anesthesia with epidural block. Transthoracic echocardiography showed LVd/LVs 38/15mm, IVS 27mm, LVPW 16mm, asymmetric septal hypertrophy, and ejection fraction of 67%.
Narrow safety ranges of preload and afterload, increasing myocardial contractility which worsens left ventricular outflow tract obstruction in HOCM may cause the circulatory management more difficult. FloTrac® monitoring system is less invasive and able to monitor arterial pressure-based cardiac output(APCO) and stroke volume variation continuously.
Using FloTrac® monitoring system, safe and stable perioperative management was achieved in spite of his severe HOCM.